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Heetman JG, van der Hoeven EJRJ, Rajwa P, Zattoni F, Kesch C, Shariat S, Dal Moro F, Novara G, La Bombara G, Sattin F, von Ostau N, Pötsch N, Baltzer PAT, Wever L, Van Basten JPA, Van Melick HHE, Van den Bergh RCN, Gandaglia G, Soeterik TFW. External validation of nomograms including MRI features for the prediction of side-specific extraprostatic extension. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00738-3. [PMID: 37932522 DOI: 10.1038/s41391-023-00738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/14/2023] [Accepted: 10/05/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Prediction of side-specific extraprostatic extension (EPE) is crucial in selecting patients for nerve-sparing radical prostatectomy (RP). Multiple nomograms, which include magnetic resonance imaging (MRI) information, are available predict side-specific EPE. It is crucial that the accuracy of these nomograms is assessed with external validation to ensure they can be used in clinical practice to support medical decision-making. METHODS Data of prostate cancer (PCa) patients that underwent robot-assisted RP (RARP) from 2017 to 2021 at four European tertiary referral centers were collected retrospectively. Four previously developed nomograms for the prediction of side-specific EPE were identified and externally validated. Discrimination (area under the curve [AUC]), calibration and net benefit of four nomograms were assessed. To assess the strongest predictor among the MRI features included in all nomograms, we evaluated their association with side-specific EPE using multivariate regression analysis and Akaike Information Criterion (AIC). RESULTS This study involved 773 patients with a total of 1546 prostate lobes. EPE was found in 338 (22%) lobes. The AUCs of the models predicting EPE ranged from 72.2% (95% CI 69.1-72.3%) (Wibmer) to 75.5% (95% CI 72.5-78.5%) (Nyarangi-Dix). The nomogram with the highest AUC varied across the cohorts. The Soeterik, Nyarangi-Dix, and Martini nomograms demonstrated fair to good calibration for clinically most relevant thresholds between 5 and 30%. In contrast, the Wibmer nomogram showed substantial overestimation of EPE risk for thresholds above 25%. The Nyarangi-Dix nomogram demonstrated a higher net benefit for risk thresholds between 20 and 30% when compared to the other three nomograms. Of all MRI features, the European Society of Urogenital Radiology score and tumor capsule contact length showed the highest AUCs and lowest AIC. CONCLUSION The Nyarangi-Dix, Martini and Soeterik nomograms resulted in accurate EPE prediction and are therefore suitable to support medical decision-making.
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Affiliation(s)
- J G Heetman
- Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands
| | | | - P Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - F Zattoni
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - C Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - S Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Special Surgery, The University of Jordan, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia
- Department of Urology, Weill Cornell Medical College, New York, USA
| | - F Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - G Novara
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - G La Bombara
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - F Sattin
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - N von Ostau
- Department of Urology, University Hospital Essen, Essen, Germany
| | - N Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - P A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - L Wever
- Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands
| | - J P A Van Basten
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - H H E Van Melick
- Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands
| | | | - G Gandaglia
- Unit of Urology/Division of Oncology, San Raffaele Hospital, Milan, Italy
| | - T F W Soeterik
- Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands.
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
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